Observation 9 - It Becomes Public (Part 2) - The Word

 They didn't hide the crisis. They gave it a name. And the name gave everyone permission to keep going. 

In 1952, three brothers from Brooklyn bought a small pharmaceutical company that made earwax remover and laxatives. What they built from it became one of the most consequential business empires in American history — and one of its most destructive.

Episode 9 goes inside the machine. How a marketing method born in the 1950s — targeting doctors instead of patients, funding the research, building the consensus — turned a controlled-release opioid into the best-selling painkiller in America. How a single sentence, drafted in a hotel room near the FDA offices in Rockville, Maryland, opened a market worth billions. And how one word — pseudoaddiction — gave an entire system permission to stop looking at what was happening.

Curtis Wright approved the drug. He went to work for the company one year later at triple his government salary.

David Haddox coined the term pseudoaddiction. He later became a vice president at Purdue Pharma.

Alice Fisher overruled the prosecutors who had spent four years building a felony case. She went to a prestigious law firm. Rudy Giuliani, Mary Jo White, and Howard Shapiro had walked into the Justice Department on Purdue's behalf to make sure that happened.

Eight hundred thousand people did not die because of evil. They died because of normal. Normal career decisions. Normal salary negotiations. Normal marketing. And a word that gave everyone in the room permission to move on to the next case.

This is Edge of the Story. We're not investigating stories. We're investigating moments people noticed.

READ FIRST — PRIMARY SOURCES

Empire of Pain: The Secret History of the Sackler Dynasty — Patrick Radden Keefe (Doubleday, 2021)

The definitive account. Everything in this episode traces to this book or to the primary sources it cites.

Pharma: Greed, Lies, and the Poisoning of America — Gerald Posner (Avid Reader Press, 2020)

Source for the declassified FBI files on Communist Party membership and Soviet connections.

DOJ Prosecution Memo — Kirk Ogrosky, October 2006

https://www.mass.gov/doc/ogrosky-memo/download

Senators Hassan and Whitehouse demand DOJ release the Purdue memo — 2019

https://www.hassan.senate.gov/news/press-releases/senators-hassan-whitehouse-press-justice-department-for-2006-purdue-pharma-prosecution-memo

PSEUDOADDICTION — THE SCIENCE (OR LACK THEREOF)

Pseudoaddiction: Fact or Fiction? — Current Addiction Reports (2015)

https://link.springer.com/article/10.1007/s40429-015-0074-7

Virginia AG lawsuit against Purdue — pseudoaddiction section (2018)

https://oag.state.va.us/consumer-protection/index.php/news/288-june-27-2018-attorney-general-herring-sues-purdue-pharma-for-lies-that-helped-create-and-prolong-opioid-crisis

 THE SACKLER FAMILY

Sackler family — Wikipedia (comprehensive sourced overview)

https://en.wikipedia.org/wiki/Sackler_family

FBI Files Expose Purdue’s Sackler Family — Just the Facts Media

https://www.justthefacts.media/p/the-red-oxycontin-kings

Purdue and Sackler Family $7.4B Settlement —

https://ag.ny.gov/press-release/2025/attorney-general-james-secures-74-billion-purdue-pharma-and-sackler-family

Harrington v. Purdue Pharma — Supreme Court Opinion, June 27, 2024

https://www.supremecourt.go

Have you ever been in a room where something shifted—but no one said it out loud?

Share your story at www.edgeofthestory.com/heard
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If we feature it, we’ll send you an Edge of the Story notebook—because some observations are worth writing down.

Transcript

800,000 Deaths And The Setup

SPEAKER_01 0:05

800,000. That is the number of Americans who died from opioid overdoses between 1999 and 2023. More than the number of Americans killed in World War II. More than the entire population of San Francisco. More than the combined populations of Wyoming, Vermont, and Alaska, 800,000 people. Not all of them traced to a single source. The crisis has moved in waves, prescription drugs first, then heroin, then fentanyl, and each wave has its own story. But economists who have studied the geography of overdose deaths have found something specific. The states where a particular marketing campaign ran most aggressively, where the sales force was largest, where the prescribing climbed highest fastest, those states have measurably higher rates of heroin and fentanyl deaths today. Not because those states have something wrong with them, because the drug that started the chain ran deeper there. The chain was built by a family from Brooklyn, whose children were turned away from American medical schools because of their religion, and who came back anyway and became doctors and built a company and developed a marketing method so effective that a Senate subcommittee called its first application a nightmare of dependence and addiction, and then used the same method again, 30 years later, with a drug twice as powerful as morphine. Today, we go inside the machine, how it was built, who protected it, and the word that made all of it feel acceptable. This is Edge of the Story.

SPEAKER_00 1:53

If you're joining us for the first time, or coming straight from episode eight, here is what you need to know. Last week we traced a thread from a dinner in San Diego in 2006 to an Oval Office signing ceremony last Saturday. A Texas governor, a Navy SEAL, a compound called Ibogaine that the federal government classified alongside heroin, while handing veterans something far more dangerous and calling it medicine. The compound the VA was handing out was OxyContin, Schedule II, accepted medical use, covered by insurance. We ended episode eight with a question: Who built that system? Who named the thing that shouldn't be named? Who approved the drug, protected the executives, and let the machine keep running? Today we answer those questions. We are going back to a doctor's office in the 1950s, to a sales call, to a method, to a family that invented it, refined it, and used it twice, first on tranquilizers, then on opioids, with consequences that are still being counted.

SPEAKER_01 2:54

Let's start in Brooklyn. Arthur, born 1913, Mortimer, born 1916, Raymond, born 1920. All three become doctors. All three are turned away from American medical schools because of anti Jewish quotas. They travel to Scotland to complete their education. The family had left Eastern Europe to escape persecution. Within one generation, they had to leave America just to get a degree. They became psychiatrists. They worked at Creedmore State Hospital in Queens, where they helped push medicine away from electroshock therapy and lobotomies toward pharmaceutical treatment. At the time, that was genuinely progressive. In 1952, they bought a small pharmaceutical company called Purdue Frederick. It made earwax remover, laxatives, and an antiseptic called betaine. What turned it into something else was Arthur.

SPEAKER_00 4:00

Arthur Sackler was not primarily a drug maker. He was the greatest pharmaceutical marketer America had ever produced. He had a client, a Swiss pharmaceutical company, with a new drug called diazepam. You know it as Valium. The drug was real. The relief it provided was real. But getting doctors to prescribe it at scale required something the industry had not done before. Direct advertising to consumers was legally restricted, so Arthur developed a different approach. You do not advertise to the patient, you advertise to the doctor. You fund the research that supports your claims, you publish in journals, you pay respected physicians to speak at conferences, you sponsor the conferences, you create the appearance of medical consensus, and then you let the consensus do the selling. By 1973, American doctors were writing more than 100 million tranquilizer prescriptions a year. A Senate subcommittee led by Senator Edward Kennedy called it, in public, on the record, a nightmare of dependence and addiction. Nobody went to prison. The method survived the hearing.

OxyContin Gets A Dangerous Label

SPEAKER_01 5:16

Declassified FBI files obtained through Freedom of Information Act requests and first reported in Gerald Posner's 2020 book, Pharma, showed that Raymond Sackler and his wife Beverly were on the 1944 membership list of the Communist Party of America's Kensington Club in Brooklyn. Mortimer refused to sign a military loyalty oath in 1952, citing federal constitutional privilege. The Army's counterintelligence detachment recommended a dishonorable discharge for both Raymond and Mortimer on grounds of disloyalty. The FBI investigated all three brothers for nearly twenty five years. The files document the investigation and the party membership. They do not document espionage or treasonous activity. What they do document is this. The men who were nearly dishonorably discharged from the United States military for disloyalty would, fifty years later, be responsible for a drug that devastated the very veterans the military was supposed to protect. That is not a conspiracy, that is irony, of the most bitter kind. Arthur Sackler died in 1987. His brothers bought his stake in the company, renamed it Purdue Pharma, and they had a new drug to sell.

SPEAKER_00 6:40

In December 1995, the FDA approved OxyContin, a controlled release formulation of Oxycodone, a derivative of heroin with pain-relieving effects twice as powerful as morphine. The approval was fast, 11 months from submission to market. The man responsible for that review was a physician named Dr. Curtis Wright IV, team leader and deputy director of the FDA's division of anaesthetic, critical care, and addiction drug products. His credentials were genuine. His job was to be the last line of defense between a pharmaceutical company's financial interest and a patient's safety.

SPEAKER_01 7:32

In that hotel room, according to the Department of Justice's own internal investigation, he allowed the company to help draft his medical officers review, the document that determined what OxyContin's label would say about addiction risk. The label that emerged included one sentence. That sentence would be used by Purdue's Salesforce in more than twenty thousand educational programs aimed at physicians. It read Delayed absorption as provided by OxyContin tablets is believed to reduce the abuse liability of a drug, is believed to, not does, not has been demonstrated to, not clinical trials have established, is believed to. No clinical study supported that belief. Early drafts of the review had indicated octocontin could be as easily abused as any other opioid. Those drafts did not survive into the final label.

SPEAKER_00 8:32

When Dr. Wright testified under oath years later about who wrote that sentence, he said he does not remember. In a 2017 Esquire interview, asked about the moment people began crushing and snorting the pills he had approved. He said, it came as a rather big shock to everybody, the government and Purdue, that people found ways to grind up, chew up, snort, dissolve, and inject the pills. A shock to everybody. The Department of Justice's own investigation found that Purdue's internal sales notes used the words crush and snort as early as 1997, one year after the drug launched. 117 internal notes recorded by sales representatives during visits to doctors. It was not a shock to Purdue.

SPEAKER_01 9:31

Title Executive Director of Medical Research, first year compensation at least$379,000, roughly three times his government salary. When asked in a twenty eighteen court deposition how he came to work for the company whose drug he had approved, doctor Wright testified as follows A recruiter contacted my home and my wife talked to him. And she thought I should talk to him and I didn't. And he called again and she suggested very firmly that I talk to him. And he and my wife convinced me that I should interview at Purdue. An unnamed recruiter, his wife's suggestion. That is the explanation offered under oath by the man whose approval opened the market for a drug that would contribute to the deaths of hundreds of thousands of Americans. He was not charged with a crime.

Pseudoaddiction Turns Alarm Into More

SPEAKER_00 10:27

When the signs of addiction began appearing, the early refill requests, the escalating doses, the behavior that doctors recognized as something wrong, Purdue had a problem. Their answer was a word. The term was pseudoaddiction, coined in 1989 by a researcher named Dr. David Haddock to describe a theoretical scenario in which a patient exhibiting what appeared to be drug-seeking behavior was actually just an undertreated pain. As a narrow clinical concept, it was not unreasonable. Dr. Haddock's later became a vice president at Purdue Pharma. The man who invented the concept went to work for the company that needed it. And Purdue turned a narrow theoretical idea into a marketing weapon, the message delivered to doctors. What looks like addiction is not addiction. The patient is in pain that the current dose cannot reach. The answer is not addiction treatment. The answer is more.

SPEAKER_01 11:54

Nearly half of the articles that acknowledge pharmaceutical industry funding listed one company as the source.

McKinsey Prices Overdoses As Rebates

Felony Cases That Never Happen

SPEAKER_00 12:02

Pseudoaddiction is a case study in what a word does when it is constructed for cover rather than clarity. It did not make the crisis invisible. It made the people who could stop it comfortable enough to keep going. It gave the sales representative something to say when the doctor raised a concern. It gave the executive something to tell himself when the overdose numbers appeared in the quarterly report. It gave the company's lawyers something to argue when the prosecutors came. It was not a lie told by monsters. It was permission. Permission to stop looking. Permission to move on to the next case. The next task. And the belief it licensed is now on 800,000 headstones. But pseudoaddiction was the answer for the doctors. Purdue had a second problem. The overdose deaths were mounting. They were appearing in newspapers. Mothers were going to Washington. Pharmacies and insurers were under pressure to restrict opioid sales. And every time a CVS tightened its dispensing policies or an insurer required additional approval before covering OxyContin, prescriptions fell. Revenue fell, the word pseudoaddiction could manage the doctor. It could not manage the body count. So Purdue hired a consulting firm to manage the body count. The firm was McKinsey Company, one of the most prestigious management consulting firms in the world. In 2017, McKinsey presented a strategy to members of the Sackler family, designed, in their own words, as documented in internal communications, later obtained in litigation, to counter the emotional messages from mothers with teenagers that overdosed on OxyContin. The strategy project how many customers of major pharmacy chains would overdose in a given year, then offer those pharmacy chains a financial payment, a rebate for each overdose attributable to OxyContin sold through their stores. McKinse projected that approximately 2,500 CVS customers would overdose in 2019. The proposed rebate, approximately$14,810 per overdose. Total proposed payment to CVS for that year alone, roughly$36.8 million. The money would not go to the overdose victim, not to the family, to CVS. Not as compensation for the families who lost someone, as a business arrangement, a payment to absorb the cost and reputational damage of the overdoses that Purdue's drug was causing, in exchange for CVS continuing to sell the drug at full volume without restricting access. Hush money, paid in advance, calculated with a spreadsheet, presented in a conference room to a family whose name was on the wall at the Louvre. In 2018, after Massachusetts filed suit against Purdue, one McKinsey consultant wrote to another that it probably makes sense to have a quick conversation with the RISC Committee to see if they should be doing anything, including, he wrote, eliminating all our documents and emails. They were discussing whether to destroy the evidence. Those documents surfaced anyway in the bankruptcy proceedings and the state attorney general lawsuits. McKinsey settled with 47 state attorneys general for$537 million. They did not admit wrongdoing. They went back to work. Their clients today include some of the largest companies and governments in the world. A former McKinsey consultant, Annandi Doradas, described it with a precision that should be read slowly. This is the banality of evil MBA edition. They knew what was going on, and they found a way to look past it, to answer the only questions they cared about, how to make the client more money. Pseudoaddiction was the word that let doctors keep prescribing. McKinsey's rebate was the strategy that let the pharmacies keep selling. Two answers to the same problem, one for the doctors, one for the business, and between them, permission for everyone to keep moving forward.

SPEAKER_01 15:57

In 2006, after a four-year investigation, a federal prosecutor named John Brownlee, United States Attorney for the Western District of Virginia, prepared a case recommending felony charges against three top Purdue pharma executives. The charges included conspiracy to defraud the United States, money laundering, and wire and mail fraud. The prosecution memorandum was written by Kirk O'Groski, Deputy Chief of the Fraud Division at the Department of Justice, six pages, later described as the most detailed prosecution memo its author had ever seen. It documented that Purdue's crimes had begun in 1992 and were still continuing, that senior executives had known about OxyContin's abuse within months of its 1996 launch, not five years later, as they would tell Congress. The deputy chief of the DOJ's own fraud section assessed the decision not to pursue those charges as a joke. His words there was no justification for which you shouldn't prosecute those individuals. None.

SPEAKER_00 17:07

The felony charges were not filed. They were overruled by Alice Fisher, head of the Department of Justice Criminal Division under President George W. Bush, after meetings with a Purdue defense team that included Rudy Giuliani, former U.S. Attorney for the Southern District of New York, former mayor of New York City, lead counsel for Purdue during the negotiations. Mary Joe White, former United States Attorney for the Southern District of New York, now representing the company her former colleagues were trying to charge. Howard Shapiro, former general counsel of the Federal Bureau of Investigation, also representing Purdue. Three of the most connected legal figures in Washington, walking into the Justice Department, the institution they had each served, to argue against their former colleagues charging their client with the felonies the evidence supported.

SPEAKER_01 17:57

The result? The company pleaded guilty to a single felony misbranding charge. Three executives, Michael Friedman, the company's president, Howard Udell, its top lawyer, Paul Goldenheim, its chief medical officer, pleaded guilty to misdemeanor misbranding charges that, by legal construction, did not accuse them of doing anything wrong. They performed community service in drug treatment programs. The prosecution evidence, all 120 pages of it, stayed sealed. Doctors who had been deceived continued prescribing by tens of millions of additional prescriptions in the five years after the settlement. No member of the Sackler family was ever criminally charged. Alice Fisher left the DOJ and became a partner at Latham and Watkins.

SPEAKER_00 18:49

The Senate subcommittee called it a nightmare of dependence and addiction in 1973. They were talking about Valium. Nobody went to prison. The method survived. Thirty years later, the same family used the same method with a drug twice as powerful as morphine, the same playbook, the same journals, the same continuing medical education programs, the same key opinion leaders paid to carry the same message, and the same word, pseudo addiction, to give everyone in the room permission to keep moving forward.

The Everyday Power Of Naming

Share Your Moment And Next Week

SPEAKER_01 19:20

On May 10th, 2007, Michael Friedman, Howard Udell, and Paul Goldenheim walked out of the federal courthouse in Roanoke, Virginia. They boarded a corporate jet back to Connecticut. In the courtroom they had just left, a woman named Lee Nuss held up a stone urn slightly larger than a pill bottle. It contained the ashes of her eighteen year old son. She told the three men, I feel you are legal drug users, nothing more than a large corporate drug cartel. The judge accepted the plea agreement. The fines were distributed. The jet landed in Connecticut. Udell went back to his office inside Purdue's building, where he continued to work as a consultant. His email, Udell Law Office at Pharma dot com. His office inside the company he had just admitted to helping mislead the public. Goldenheim eventually returned to practicing medicine in Boston. When a student at Phillips Exeter Academy where Goldenheim sat on the board demanded his removal, the board president defended him, saying he had acted in accordance with the highest ethics of his profession. He eventually stepped down. Friedman went quiet. The machine kept running. Today's episode is about a word pseudoaddiction, and what that word allowed an entire system to do. But words like that don't only live in pharmaceutical boardrooms, they live in smaller rooms, in the doctor's office where someone was told the symptoms were stress, in the hospital room where a family was told the prognosis was good, in the conversation where a diagnosis was delivered with such confidence that it never occurred to anyone to ask whether the confidence was earned. It doesn't have to be criminal. Most often it is not. It is expeditious. It is the word that lets the doctor move to the next patient. The word that lets the system take the next step without accounting for the last one. There is no evil intent. There doesn't need to be, there only needs to be permission. Have you ever been in that room? The room where someone you trusted gave something a name, not out of malice, but out of the ordinary human need to move forward, and that name shaped everything that came after? We want to hear about the moment you were in the room when a word did work it wasn't qualified to do, when permission was granted, and what you noticed. Find us at www. dot edge of the story dot com slash heard. We read everything. We said at the start of this show we're not investigating stories. We're investigating moments people noticed. Here is what makes this story different from every other one we've told this season. Everyone noticed the sales representatives who wrote the word snort in their visit notes noticed. The executive who said he was reminded of MS Contin when the overdose report started coming in noticed. Richard Sackler noticed well enough to write an email calling addicts reckless criminals. You cannot direct blame at something you have not noticed. Curtis Wright noticed that the language he approved had no clinical evidence behind it. Alice Fisher noticed that the prosecutors had one hundred and twenty pages. She read it, she made a call, everyone noticed, and everyone had a word that gave them permission to keep moving. The machine did not require monsters, it only required people willing to do their jobs, take their paychecks, use the available word for what they were seeing. And on may tenth, two thousand seven three of those people boarded a corporate jet in Roanoke and flew home. The machine kept running and next week we go inside it to see what it did next in part three. Not in a courtroom not in a DEA report in a spreadsheet with a dollar amount attached to every overdose. Next week on Edge of the Story Edge of the Story is produced high atop Chalk Mountain. If the gate is open come on in and we will talk a while. Every source for this episode is in our show notes, every name, every document, every study. We don't hide our work we're not investigating stories, we're investigating moments people's see you next week when we conclude with part three of this story